Tasneem Clarke, Research Officer, Money and Mental Health
Personal recovery, personal budget: Why are personal budgets under-used in mental health?
There is nothing more personal than what goes on in the privacy of your own mind: how each individual journeys towards recovery from a mental health problem can vary as widely as their preferred lifestyles, hobbies or foods.
The introduction over the past 10 years of personal budgets for health and social care represents an attempt to recognise this and give people more choice and control about their care. People are allocated a budget to meet their recognised social or health care needs and, as the expert in their own care, the person themselves can say how it should be spent to help them stay healthy and independent.
It sounds perfect for people with mental health conditions, who so often have their choice and agency taken away through restrictive policies, laws or societal misunderstanding, and whose needs and aspirations vary widely. I’ve lost count of the people I’ve met who feel they could make such leaps forward if only they could afford an art class or had someone to accompany them on the bus to a group activity.
“I paid privately for regular counselling as this is unavailable on the NHS…once I was able to take tentative steps into the world again, I began a gym membership in order to use the private swimming pool (people are scary, private pools are smaller and emptier) and after a further year to join in yoga and pilates classes.”
Independent evaluations have confirmed that personal budgets are particularly effective for, and appreciated by, people with mental health needs. They are also less costly and reduce use of other health services. Yet strangely, they are not being used for this group as much as for others, which may be to do with the people allocating and managing them.
A technical maze
Personal budgets can be allocated by either the NHS or the council, depending whether it’s seen as “continuing health care”, or as a social care need which may have arisen from a health problem. The decision about who is responsible for the care can then impact on the the likelihood of it being provided through a personal budget or through traditional models due to organisational priorities and culture.
Once allocated, personal budgets can be managed by an authority like a local council, by a third party, through “Direct Payments” that the person manages themselves, or by a combination of the above. People who manage their own budgets report the highest levels of positive outcomes, but must also take responsibility for accounting for spending, and for any employees – like a personal assistant. Although help is available for managing these responsibilities, personal budgets, and especially Direct Payments, are less often used for people with mental health needs.
Don’t throw out the baby with the bathwater
Even when eligibility is established, decision makers may have worries about someone with a mental health problem being able to cope with one. We know that a period of poor mental health can make it more difficult to manage a budget, but also that such difficulties are usually time-limited:
“I do feel very competent and thorough when I’m well, and am very aware of my finances and getting the best deal etc, but when I’m not well I find it too tiring and mind boggling to even think about my finances.”
We all have times when we feel less able, and there is no reason to allow those to limit the opportunities that are available to us at other times. A personal budget should be no exception. What the budget will be spent on is already agreed with the budget provider at the time it is allocated, during a period when the person is well enough to be involved in the decision-making. Even if a person has previously had problems managing money when unwell, a flexible approach could be used where payments could be set up by direct debit or managed by a third party at certain times so that the money can’t get diverted elsewhere, or neglected during a period of poor mental health.
With great power comes great responsibility
The flip-side of taking control over a budget to spend on your own recovery is that you must also take responsibility for it – but that doesn’t mean that you can’t be supported to do so. Throughout Money and Mental Health’s work we are advocating for greater choice, control, and flexibility wherever there are mechanisms for people to manage money. We are asking banks, retailers and credit providers to allow people to put in place tram-lines, controls or extra processes when they are well, to help them avoid harm in periods when they are unwell. It’s about supporting people to stay in control, not about taking it away from them. Why shouldn’t councils and the NHS do the same?